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      Where children and adolescents drown in Queensland: a population-based study

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          Abstract

          Objective

          This retrospective population-based study examined drowning location by the site of immersion for both fatal and non-fatal drowning events in Queensland. Drowning location is not routinely collected, and this study used data linkage to identify drowning sites. The resulting enhanced quality data quantify drowning incidence for specific locations by geographic region, age group and by severity for the first time.

          Design

          Linked data were accessed from the continuum of care (prehospital, emergency, hospital admission and death data) on fatal and non-fatal drowning episodes in children aged 0–19 years in Queensland for the years 2002–2008 inclusive.

          Results

          Drowning locations ranked in order of overall incidence were pools, inland water, coastal water, baths and other man-made water hazards. Swimming pools produced the highest incidence rates (7.31/100 000) for overall drowning events and were more often privately owned pools and in affluent neighbourhoods. Toddlers 0–4 years were most at risk around pools (23.94/100 000), and static water bodies such as dams and buckets—the fatality ratios were highest at these 2 locations for this age group. Children 5–14 years incurred the lowest incidence rates regardless of drowning location. Adolescents 15–19 years were more frequently involved in a drowning incident on the coast shoreline, followed by inland dynamic water bodies.

          Conclusions

          Linked data have resulted in the most comprehensive data collection on drowning location and severity to date for children in the state of Queensland. Most mortality and morbidity could have been prevented by improving water safety through engaged supervision around pools and bath time, and a heightened awareness of buckets and man-made water hazards around the farm home for young children. These data provide a different approach to inform prevention strategies.

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          Most cited references34

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          A new definition of drowning: towards documentation and prevention of a global public health problem.

          Drowning is a major global public health problem. Effective prevention of drowning requires programmes and policies that address known risk factors throughout the world. Surveillance, however, has been hampered by the lack of a uniform and internationally accepted definition that permits all relevant cases to be counted. To develop a new definition, an international consensus procedure was conducted. Experts in clinical medicine, injury epidemiology, prevention and rescue from all over the world participated in a series of "electronic" discussions and face-to-face workshops. The suitability of previous definitions and the major requirements of a new definition were intensely debated. The consensus was that the new definition should include both cases of fatal and nonfatal drowning. After considerable dialogue and debate, the following definition was adopted: "Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid." Drowning outcomes should be classified as: death, morbidity, and no morbidity. There was also consensus that the terms wet, dry, active, passive, silent, and secondary drowning should no longer be used. Thus a simple, comprehensive, and internationally accepted definition of drowning has been developed. Its use should support future activities in drowning surveillance worldwide, and lead to more reliable and comprehensive epidemiological information on this global, and frequently preventable, public health problem.
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            Interventions associated with drowning prevention in children and adolescents: systematic literature review.

            Drowning remains a leading cause of preventable death in children across the world. This systematic review identifies and critically analyses studies of interventions designed to reduce fatal and non-fatal drowning events among children and adolescents or reduce the injury severity incurred by such incidents.
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              Characteristics of drowning by different age groups.

              L. Quan (2003)
              While it is known that the risk of unintentional drowning varies with age, the manner in which drowning episode characteristics vary by age has not been well described. Such information might be useful for prevention. To describe characteristics of drowning by age group. Retrospective review of the characteristics of drowning victims and their drowning incidents obtained from death certificates, medical examiner, pre-hospital, emergency department, and hospital records. Three counties in Western Washington state. Residents who died (n=709) of unintentional drowning within the study region during 1980 through 1995. Age specific counts, proportions, and rates per million person years were estimated for and compared among six age groups. Rates varied by age group: 0-4 (30.5), 5-14 (11.6), 15-19 (29.9), 20-34 (21.5), 35-64 (12.5), and 65 years or older (21.2). Among those 0-4 years, the proportions that drowned in pools, bathtubs, and open water were nearly equal. But from age 5-64 years, over 69% of deaths were in open water. Among those 65 years and older, the deaths were almost evenly divided between bathtub and open water; bathtub drowning rates were highest in this age group, 10.9. Pre-drowning activities were divided into boating, swimming, car passenger, bathing, and fell in while doing something else. Most (64/89, 76%) victims aged 0-4 years drowned while bathing or after falling in. Among those 15-19 years, most occurred while swimming (24/79, 34%) or boating (22/79, 31%). The drowning event was least often witnessed among those 0-4 years (10/36, 28%), and most often witnessed (44/58, 76%) among those 15-19 years. Medical care (pre-hospital, emergency department, or hospital) was most often involved in drownings of those 0-4 years (70/89, 79%) and least among those over 65 years (11/86, 13%). The characteristics of drowning episodes vary greatly by age. Different prevention strategies may be needed for different age groups.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2015
                26 November 2015
                : 5
                : 11
                : e008959
                Affiliations
                [1 ]Centre for Children's Burns & Trauma Research, Queensland University Child Health Research Centre, Lady Cilento Children's Hospital , Brisbane, Queensland, Australia
                [2 ]Dept of Paediatric Surgery, Urology, Burns & Trauma , Lady Cilento Children’s Hospital, Brisbane, Queensland, Australia
                [3 ]College of Public Health, Medical and Veterinary Sciences, James Cook University , Townsville, Australia
                [4 ]Royal Life Saving Society Australia , Townsville, Queensland, Australia
                Author notes
                [Correspondence to ] Belinda A Wallis; belinda.wallis@ 123456uqconnect.edu.au
                Article
                bmjopen-2015-008959
                10.1136/bmjopen-2015-008959
                4663452
                26610762
                a4e01409-ef93-459e-9b1b-5436334d74ec
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 3 June 2015
                : 16 September 2015
                : 19 October 2015
                Categories
                Paediatrics
                Research
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                Medicine
                education & training (see medical education & training),epidemiology,respiratory medicine (see thoracic medicine)

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